Form Sfn 509 – Fill Out and Use This PDF

Form Sfn 509 PDF Details

Navigating the requirements for out-of-state facilities wishing to provide services to North Dakota Medicaid recipients involves understanding and completing the SFN 509 form. This form, issued by the North Dakota Department of Human Services Medical Services, is a crucial step for any facility looking to extend its services to Medicaid beneficiaries not within its immediate geographic location. It outlines a process where these facilities must demonstrate their capability and reason for billing North Dakota Medicaid by providing detailed information about at least one Medicaid-eligible recipient they plan to serve or have already served. The form asks for essential data including the patient or recipient's name, date of birth, address, a brief description and circumstances of services rendered, the referring physician, and the date of service. This ensures that the North Dakota Medicaid program can verify and process requests from out-of-state providers efficiently and effectively, aiming to expand access to care for its recipients while maintaining stringent oversight on the services paid for with Medicaid funds. Completion and submission of the SFN 509 to the Provider Enrollment sector of DHS Medical Services is the first step in a crucial journey toward broadening the scope of care and support available to North Dakota Medicaid recipients, making it an essential document for out-of-state providers.